Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH00001805 | WA |
NPI | 1649252180 |
---|---|
Provider Name | Dr. Wayne Walter Moore |
First Address | Gig Harbor, WA 98335-1100 |
Second Address | Gig Harbor, WA 98335-1100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 08/07/2007 |